breast milk for preterm infants

Breast Feeding Preterm Infants – The Role of Donor Milk

• Importance • Needs of the Preterm • Role• Critically Appraise• Future

• Not just a food • Health Benefits for mother and baby

Short Term Benefits Long Term Benefits

LRTI’s OR 0.36 95% CI 0.18 to 0.74

Risk of Breast Cancer

Risk varied 4.3% and 28%

Obesity OR 0.78 95% CI 0.72 to 0.84

Risk of Ovarian Cancer

OR 0.79 95% CI 0.68 to 0.91

SIDS OR 0.64 95% CI 0.51 to 0.81

Risk of Type 2 Diabetes

OR 0.63 95% CI 0.54 to 0.73

Hoddinott et al. BMJ 2008;336;881-887

Increased Calories

Phosphate Supplements Protein and

Calcium

Iron supplementation

Impaired Thermoregulation

Co-Morbidities• Respiratory Distress Syndrome• NEC• PDA

Rapid Growth

28 week Preterm – Doubles weight in 6 weeks, trebles in 12

weeksTerm infant – Doubles weight in 4.5 months,

trebles in 1 year

Decreased absorption – especially fats

Invasive procedures

Lissauer T, Clayden G. Illustrated Textbook of Paediatrics. Ch10 p153-4

• WHO guidance – Provide mothers milk to all preterm infants– Promote the use of mothers milk in neonatal units– Support Mothers

MATERNAL MILK IS FIRST CHOICE

Edmond K, Bahl R. Geneva WHO, 2006. Henderson G, Anthony M, McGuire W. Cochrane Database Syst Rev 2007;(4):CD002972.

• 2250 BC – Code of Hammurabi

• 13th Century – Highest paid job for a woman

• 20th Century – Decline

• Today – second choice

hmbana.orgEdmond K, Bahl R. Geneva WHO, 2006.

Constituents Breast Milk Davies 1977 (Term)

Lucas 1984 (Term)

Gross 1983 (Term + Preterm)

Energy (kcal) 62 71 46 66.8

Protien (g) 1.3 1.1 1.07 1.01

• UKAMB Guidelines • Expressed Milk and Drip Milk• Significant variation in composition• Why women donate

Pimenteira AC et al. JHum Lact. 2008;24:69-75

• Holder Pasturisation• Remove Bacterial contamination• HIV, HTLV, CMV – Eliminated • Little effect on LC-PUFA’s• B and T cell destroyed• IgA and sIgA – 20% reduction• Human milk lipases destroyed

Tully DB, Jones F et al. J Hum Lact 2001;17(2):152-5

• Donor Milk vs Formula Milk for Preterm infants

• 14 trials – 6 excluded • Only 1 trial since 2000 – rest 1970’s and 80’s

• Formula as suppl to MBM – Schanler et al. Lucas et al.

• Nutrient fortified DBM – Schanler et al.

Quigley MA et al. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD002971.

Head Circumference (cm) at 7.5 – 8 years

Neuro Impairment at 18 months

• Schanler et al. 2005– RCT – donor vs preterm formula as

supplement to MBM– Fortified– 243 infants (23-29 weeks gestation)

MM and DM had 6% incidence of NEC, PF had an 11% incidence (p-value: 0.27)

Schanler RJ et al. Pediatrics.2005;116(2):400-6

• New Milk Banks opening throughout the UK– RDE only bank in the South West– 45 donors last 3 years– 72 babies in the unit have benefited

• Update on the use of donor milk NICE guidelines

www.nice.org

• High cost• Has to be worth it

• Insufficient evidence• Big study with significanceBristol• Not yet • Possibility for the future

• Hoddinott P, Tappin D, Wright C. Breast Feeding. BMJ. 2008;336:881-887• Lissauer T, Clayden G. Illustrated Textbook of Paediatrics. Ch10 p153-4 • Edmond K, Bahl R. Optimal feeding of low birthweight infants, technical review Geneva

WHO, 2006http://whqlibdoc.who.int/publications/2006/9789241595094_eng.pdf• Henderson G, Anthony M, McGuire W. Formula milk vesus maternal breast milk for

feeding preterm or low birthweight infants. Cochrane Database Syst Rev 2007;(4):CD002972.

• Jones F 2003. http://www.hmbana.org/index.php?mode=history• www.ukamb.org • Thomaz ACT, Loureiro LVM, Oliveira TS, Mendonca NC, Montenegro F et al. The Human

Milk Donations experience: Motives, influencing factors, and regular donation.J Hum Lact 2008;24:69-76

• Quigley MA, Henderson G, Anthony MY, McGuire W. Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD002971. DOI: 10.1002/14651858.CD002971.pub2

• Lucas A, Gore SM, Cole TJ, Bamford MF, Dossetor JFB, Barr I, Cork S, Lucas PJ. Multicentre trial on feeding low birthweight infants effects of diet on early growth. Arch Dis Child;1984;59;722-30.

• Davies DP. Adequacy of expressed breast milk for early growth of preterm infants. Arch Dis Child;1977;52;296-301

• Gross SJ. Growth and biochemical response of preterm infants fed human milk or modified infant formula. NEJM;1983;308;5;237-241.

• Tully DB, Jones F, Tully MR. Donor Milk: What’s in it and What’s not. J Hum Lact.2001;17(2):152-5

• Schanler RJ, Lau C, Hurst NM, O’Brian Smith E.Randomised trial of donor human milk versus preterm formula as substitutes for mothers’ own milk in the feeding of extremely premature infants. Pediatrics.2005;116(2):400-6

• www.Nice.org.uk

Thank You